White Coat Adherence Effect on Glucose Control in Adult Individuals with Diabetes

Abstract

Background White coat adherence (WCA) is defined as an increased adherence to treatment regimens directly before a visit with a healthcare provider. Little is known on the effect of WCA on glucose control in adult patients with diabetes mellitus. Methods The present study is based on 618 CGM-observations of 276 patients with diabetes treated between January 2013 and July 2018. The analysis compares data from the 3 days prior to a visit (p1) with the preceding 25 days (p2). Results Sensor use was higher during p1 than p2 (92.8±7.3% vs 88.8±7.5%; p<0.001). Mean glucose [MG] and coefficient of variation [CV] were lower in p1 compared to p2 (MG 163.9±39.2 mg/dL vs 166.9±35.7 mg/dL, p=0.001; CV 33.5±8.4% vs 36.0±7.0%, p<0.001; respectively). Time in range (70-180mg/dL) was higher in p1 than p2 (61.4±21.2% vs 60.0±18.4%, p=0.002). Sensitivity-analysis showed that WCA effect was mainly detected in patients with HbA1c > 7% [53mmol/mol]. Conclusion This study reveals a WCA effect on pre-visit glucose control in adult patients with diabetes. The effect was most pronounced in patients with moderate to poor glycemic control. In these patients, analysis of CGM data should encompass a minimum of 1 to 2 weeks prior to a consultation.